Provider Demographics
NPI:1245540772
Name:LEE, VALERIE VERONICA (IDMT)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:VERONICA
Last Name:LEE
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N POINT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:62208-2437
Mailing Address - Country:US
Mailing Address - Phone:575-770-2939
Mailing Address - Fax:
Practice Address - Street 1:210 N POINT RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2437
Practice Address - Country:US
Practice Address - Phone:575-770-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians